Intraperitoneal behaviour of a new composite mesh (ParietexTMComposite Ventral Patch) designed for umbilical or epigastrichernia repair

Abstract

Introduction The most common treatment option for ventral and umbilical hernias is the implant of a prosthetic mesh. This study compares the behaviour of a new mesh, ParietexTM Composite Ventral Patch (Ptx), with two commercially available meshes, VentralexTM ST Hernia Patch and ProceedTM Ventral Patch. Materials and methods The following meshes were tested in a umbilical-hernia repair model using 54 rabbits: VentralexTM ST Hernia Patch (Vent) (Bard Davol Inc., USA); ProceedTM Ventral Patch (PVP) (Ethicon, USA) and Ptx (Covidien, Sofradim, France) (n = 18 each). At 3, 7 and 14 days postimplantation, peritoneal behaviour and adhesion formation were assessed by sequential laparoscopy. Adhesions were scored for consistency and quantified by image analysis. The animals were euthanized at 2 (n = 27) and 6 weeks (n = 27) postsurgery. Mesothelial cover of meshes and tissue ingrowth were determined by scanning and light microscopy. Results Seroma was observed in 1/18 Vent, 7/18 PVP and 4/18 Ptx, mainly between the implant and subcutaneous tissue. Firm omental adhesions between the mesh and parietal peritoneum were noted in 2/9 Vent, 6/9 PVP and 3/9 Ptx at 2 weeks and in 3/9 Vent, 5/9 PVP and 1/9 Ptx at 6 weeks. Three (out of 9) encapsulated PVP implants showed ??tissue-integrated?? adhesions affecting the intestinal loops. No differences between implants were detected in the surface area occupied by adhesions at 2 weeks, though at 6 weeks, percentages were significantly higher (p < 0.01; Mann?Whitney U test) for PVP compared to Ptx or Vent. At this time point, Ptx and Vent showed good host tissue incorporation and optimal mesothelialization. Conclusions The PVP implants showed greater adhesion formation than the other materials. Postimplantation behaviour was comparable for Ptx and Vent including scarce adhesion formation and optimal mesothelialization. Regarding tissue integration, Ptx showed greater long-term collagenization of the neoformed tissue.